Hospice Mistreatment and Federal Sanctions

Are our elderly loved ones receiving proper end-of-life care at California hospices? A recent article in the Huffington Post reported that, unlike other healthcare facilities that receive Medicare funding, hospices aren’t being punished sufficiently when they commit elder abuse and violate rules related to patient health and safety. To be sure, when a hospice fails to provide the promised comfort and care at the end of a person’s life, “it almost always escapes sanctions.” Why isn’t the federal government punishing these hospices for failing to do their jobs?

Inspections Don’t Yield Sanctions

One of the primary issues, the article suggests, is that federal regulators just aren’t doling out sanctions to hospices in the same way that they often do for nursing homes. The problem isn’t that the federal government isn’t investigating claims of abuse, neglect, and patient mistreatment at hospice facilities. Indeed, “inspections do occur and problems are identified,” yet inspectors often tend to accept “hospices promises that they’ll reform.”

The statistics seem to prove this point. Medicare’s federal regulator, according to the Huffington Post researchers, “has punished a hospice just 16 times in the last decade, despite carrying out 15,000 inspections and identifying more than 31,000 violations.” To put those numbers in perspective, only .05 percent of identified violations have resulted in a sanction. And what do these sanctions look like? Federal law only has one available for hospice violations—terminating the hospice’s license. In these cases, the loss of a license typically results in the close of the hospice facility.

While all of the identified violations haven’t been serious—some, for instance, have involved minor issues like a dead battery in a smoke detector—other violations have been life-threatening. For example, federal inspectors have listed violations such as “administering the wrong dose of medicine in error and killing a patient as a result.” Medicare pays a majority of hospice claims, yet signs of serious problems don’t seem to be limiting that funding in a salient way.

Medicare “Bankrolls” For-Profit Hospices

Given that Medicare pays a large portion of claims from hospices, it’s especially disconcerting that federal investigators aren’t issuing more sanctions for obvious violations. But what’s more problematic, perhaps, is that much Medicare funding appears to be “bankrolling” a number of for-profit hospice facilities that have cropped up over the last decade.

In recent years, the federal government has cracked down on a number of these for-profit facilities, but not because of patient safety issues. Rather, many for-profit hospices have engaged in Medicare fraud, taking on patients who are “not close enough to death to qualify for the service,” such as Alzheimer’s and Parkinson’s patients, or “boosting them to extra-expensive levels of care they didn’t need.”

In addition to identifying fraudulent practices at for-profit hospices, it’s important for the federal government to take a closer look at patient safety in both for-profit and non-profit facilities. Will elder care at hospices become a more important concern in 2015? In 2014, Americans took a close look at assisted-living facilities in California and called for more action to prevent elder abuse and neglect. We’ll need to wait and see whether violations at hospices will be handled in a similar manner this year.

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